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Whereas the previous chapters of this book focused on how to deliver evidence-based CBTx at the patient level, this chapter seeks to consider and challenge readers on how to design, deliver, and implement CBTx for insomnia scale. It outlines the strengths of different delivery methods of CBT (e.g., individual, group, telehealth, books, and digital) and puts forth the case that digital therapeutics (DTx) can serve as a means of fulfilling clinical guideline care for insomnia at scale. Next, the chapter focuses on how guideline-recommended treatment can be delivered in an efficient manner through a stepped care approach that utilises the variety of delivery methods available. The chapter proceeds to outline a care-delivery model at the ecosystem level to treat the widest possible population, taking into account treatment guidelines and real-world examples such as the role of medication and different care pathways. It goes on to describe how to provide a specialised insomnia service within different clinical services and concludes by highlighting key partnerships and alliances for the future of insomnia CBTx.
Chapter 6 analyses narrative representations of local women, who feature throughout UN mediation texts as ‘the women’. This subject position is multifaceted and articulated differently according to different logics of UN mediation. Especially within the logic of UN mediation as a science, ‘the women’ are expected to play a legitimating, information-providing role to support the UN. This is an extractive, rather than an empowering, relationship. UN narratives position ‘the women’s’ labour as central to mediation effectiveness, but they also question their abilities and authenticity as representatives of their communities. Capacity-building training is one method that the UN, and particularly gender advisors, use to discipline women into appropriate forms of participation. The logic of UN mediation as an art has less use for 'the women' in its narratives and instead questions whether they are 'political enough' to be appropriate representatives in negotiations. In turn, local women resist and navigate the subject position of ‘the women’ through strategic essentialism, critique, or opting out.
The book’s final chapters engage with the actor (and spectator) as translational agent and site. Chapter 3 considers performances by what playwright-dramaturg Kaite O’Reilly calls the atypical actor, focusing on how current conversations in disability and Deaf studies and in theatre, dance, and performance translation studies might mutually illuminate. To illustrate, the chapter examines first the author’s performance work with deaf performance artist Terry Galloway and the Mickee Faust Club and its “ethic of accommodation,” counterposing an ethic of translationality that avoids accommodation’s asymmetric power dynamic. Next considered are O’Reilly’s plays and dramaturgical practices, where translationality can be seen operating between individuals, institutions, and cultures and highlighting the artistic potential for incorporating into performance frequently sidelined access devices. The chapter continues, adopting a translational approach to actor training and casting before concluding with self-translation as perhaps an even more effective disruptor of the prevailing disability-as-theatrical-metaphor, returning first to Galloway and the author’s participation in the Disability and Deaf Arts festival production of The Ugly Girl before closing with reflections upon watching disability rights activist and well-known British actor Liz Carr perform in Assisted Suicide: The Musical, a master-class in self-translation.
Drug addiction is rife in Nepal, with a high relapse rate following treatment. Apart from basic psychosocial support, there are no evidence-based aftercare services for individuals in recovery. Recently, mindfulness-based interventions have shown promising results in preventing relapse. We discuss the context, challenges and opportunities of organising a 2-day intensive face-to-face mindfulness-based training for Nepalese mental health professionals to facilitate 8-week mindfulness-based relapse prevention (MBRP). Altogether, 24 participants completed the feedback questionnaire. Most were rehabilitation staff, along with a few psychologists and psychiatrists. Feedback suggested a high degree of satisfaction and provided comments to improve the programme. It has prompted us to design online MBRP training and set up a feasibility study for an MBRP programme in Nepal. If successful, this may help a huge number of individuals in recovery.
Entrustable professional activities (EPAs) have gained traction in the medical education field as a means of assessing competencies. Essentially, an EPA is a profession-specific task that a trainee is entrusted to conduct unsupervised, once deemed competent by their supervisor through prior evaluations and discussions. The integration of EPAs into postgraduate assessment strategies enhances the delivery of capability-based curricula. It strategically bridges the theoretical–practical divide and addresses existing issues associated with workplace-based assessments (WBPAs). This article aims to (a) provide an overview of EPAs, (b) review the application of EPAs in postgraduate psychiatry so far, exploring their conceptual framework, implementation, qualities and potential benefits and concerns, and (c) propose a theoretical framework for their integration into the UK psychiatry curriculum.
A clinical research team’s goal is to support the implementation, conduct, and monitoring of research studies and corresponding protocols. There is a need to ensure that study teams have adequate resources and regulatory support to successfully adhere to regulations and good clinical research practices. Our team, the UC Davis Division of Infectious Diseases Research Unit (IDRU), sought to establish a One Signature Initiative program for all studies and protocols supported by the IDRU. The One Signature Initiative designates one point of contact from each ancillary team or department to sign delegation and training logs, who in turn is delegated to train their team. The goals of the One Signature Initiative were, and are still, to reduce task redundancy, lessen regulatory burden on research teams, and minimize audit findings. Since the implementation of the One Signature Initiative in 2023, acceptance has been favorable, and we have expanded its footprint by incorporating it into our standard operating procedures. This article discusses our experiences, and ancillary departments’ experiences, with the One Signature Initiative. Our experience is an example of how a One Signature Initiative can be developed that is efficient, effective, and well-accepted by clinical research stakeholders.
This chapter examines the acquisition of vowels and consonants in perception and production during typical second language (L2) acquisition by sequential, dominant bilinguals. The acoustic and articulatory studies reviewed serve to illustrate general patterns of L2 segmental learning with a focus on four principal themes, each structured around one or two main research questions: 1) cross-linguistic influence (How does a sequential, dominant bilingual’s first language shape L2 segmental perception and production?); 2) development (Are there universal patterns to L2 segmental speech development? Are certain vocalic and consonantal phenomena acquired more easily?); 3) inter- and intralearner variability (What are the sources of differences in perception and/or production between learners and for the same learner over time and in different communicative contexts?); and 4) training effects (What are the effects of training on learning? How do variables such as task and stimuli type condition effectiveness?).
Italy often experiences major events, such as earthquakes, floods, and migrant shipwrecks. Current and future global challenges for health workers are made up by climate change, pandemics, and wars. In this work, we will assess the state-of-art of training and interest towards these challenges among Italian post-degree public health schools.
Methods
A cross-sectional survey was conducted in Italy in June 2023 among Italian public health residents. The study investigated training levels and updates regarding emergencies in Italian residencies. It also analyzed interest and importance of topic, impact of the COVID-19 pandemic, and sources of information.
Results
Of 289 respondents, 86.2% deemed the topic important and 74.4% expressed interest. 90.1% pointed out the lack of dedicated courses and 93.1% of specialized master’s programs. Perceived importance in the topic was associated with the desire to attend dedicated conferences. As for COVID-19, 24.6% recognized the importance of this topic pre-pandemic, while 50.9% raised awareness during the pandemic.
Conclusions
This survey shows the need for the offer of emergency training programs in Italian public health schools. Professionals in public health can make a great contribution to emergencies, not only in preparedness, but also in response and recovery phases.
The aims of this study were to explore the knowledge of EMS physicians (EMSPs) on the legal aspects related to the management of prehospital psychiatric emergencies, assess their degree of comfort, and measure their perceived communication skills.
Methods
A survey was distributed to the 376 EMSPs working in the prehospital setting in Lombardy, Italy. Knowledge of medico-legal aspects was measured through multiple-choice questions; the Comfort Score (CS) and perceived Communication Skills Score (CSS) were calculated using Likert Scale questions. CS ranged from 11 points (lowest) to 44 (highest); CSS ranged from 8 points (lowest) to 32 (highest).
Results
A total of 272 EMSPs answered the survey (RR= 72.3%); 45.2% were women. Mean age was 45.76 years (SD 8.8). Mean percentage of correct knowledge test answers was 52.4 (SD 12.3); 81.3% believed to have little knowledge of the Italian legislation regarding this topic. Mean CS was 29.3 (SD 5.5); mean CSS was 19.1 (SD 3.9). A higher percentage of correct answers in the knowledge test was associated with lower CS (P = 0.019). Higher self-appraised knowledge of the Italian legislation was associated with higher CS (P < 0.001) and higher CSS (P < 0.001).
Conclusions
These findings should prompt policy makers to ensure proper training and support for EMSPs in the matter of prehospital psychiatric emergency management.
Charisma, often seen as an innate trait, is now understood as leader signaling grounded in values, symbols, and emotions, suggesting it can be developed through interventions. However, the method for cultivating charisma remains unclear. This study examines nonverbal communication strategies, highlighting the potential of body language, facial expressions, and vocal modulation to enhance charisma. Additionally, we introduce a virtual reality training program focused on these cues and explore the role of audience presence in boosting the intervention’s effectiveness by fostering self-awareness and behavioral adjustments. Results of a controlled randomized experiment with virtual reality-trained participants and online charisma assessors demonstrated significant improvements in observer-rated charisma from pre- to post-training compared to the control group. Moreover, training in front of a virtual audience yielded the expected outcomes. This study sheds light on charisma theory, its potential virtual reality training application, and its implications for leadership development.
This chapter looks at the history of three institutions operated by the Territory of Hawaiʻi: the Waialeʻe Industrial School for Boys (opened in 1902), the Kawailoa Training School for Girls (opened in 1929), and the Waimano Home for the Feeble-Minded (opened in 1921). The combined rhetorics of correction and care for Hawaiʻi’s children at play in these carceral institutions echoed the broader, paternalistic justifications for annexing Hawaiʻi as saving the islands both from other colonial empires and a Hawaiian Kingdom that white settlers characterized as uncivilized and childish. The Territorial government repeatedly used the scientific imprimatur of work by those like psychologist Stanley Porteus as well as models of training schools and homes for the “feebleminded” in the continental United States as justifications for institutionalizing Native Hawaiians and immigrants of color. This chapter focuses on two main themes. The first tracks the settler colonial process of pathologizing Native Hawaiian and other non-white forms of kinship and care, and attempts to replace it with institutionalized care. The second theme examines how a critical history of these institutions offers a different picture of the Territorial period in Hawaiʻi.
The Australian Army served in numerous theatres and campaigns throughout World War II, earning distinction and at times facing significant challenges. During the Pacific War, the infantry brigade, as an intermediate formation commanding multiple infantry battalions and numerous attached units, was key in Australian efforts to secure victory. The 18th Infantry Brigade participated in a variety of combat operations with a range of allies allowing it rare experience among Australian units. It's involvement in operations from Europe to the Middle East and onto the Pacific ensured that it was one of the most modern brigades at the close of the war. Assault Brigade examines the challenges and development of the Australian Army's 18th Infantry Brigade throughout World War II. It investigates a series of campaigns fought across the South West Pacific Area, highlighting lessons learnt and adaptations implemented as a result of each battle.
Creating a sustainable residency research program is necessary to develop a sustainable research pipeline, as highlighted by the recent Society for Academic Emergency Medicine 2024 Consensus Conference. We sought to describe the implementation of a novel, immersive research program for first-year emergency medicine residents. We describe the curriculum development, rationale, implementation process, and lessons learned from the implementation of a year-long research curriculum for first-year residents. We further evaluated resident perception of confidence in research methodology, interest in research, and the importance of their research experience through a 32-item survey. In two cohorts, 25 first-year residents completed the program. All residents met their scholarly project requirements by the end of their first year. Two conference abstracts and one peer-reviewed publication were accepted for publication, and one is currently under review. Survey responses indicated that there was an increase in residents’ perceived confidence in research methodology, but this was limited by the small sample size. In summary, this novel resident research curriculum demonstrated a standardized, reproducible, and sustainable approach to provide residents with an immersive research program.
Field schools are foundational training for archaeologists and the corresponding methods for instruction are largely consistent within the discipline. The expectation is that at some point early in their careers students will enroll in a field school. To participate, students must pay summer tuition, dedicate a minimum of four weeks (usually longer) to full-time fieldwork, and in many cases travel to remote locations. The reality is that for many students such expectations make field school participation an impossibility—and ultimately make archaeology a nonviable career option for students from historically underrepresented backgrounds. Offering local field opportunities within the context of a regular school year alleviates those problems. A recent field school in north Idaho demonstrated how traditional field school structure excludes many students and how archaeologists can adjust instruction to make field training more accessible to students.
Demonstrating the impact of implementation science presents a new frontier for the field, and operationalizing downstream impact is challenging. The Translational Science Benefits Model (TSBM) offers a new approach for assessing and demonstrating research impact. Here we describe integration of the TSBM into a mentored training network.
Methods:
Washington University’s Clinical and Translational Science Awards TSBM team collaborated with a National Institute of Mental Health-supported training program, the Implementation Research Institute (IRI), a 2-year training institute in mental health implementation science. This partnership included three phases: (1) introductory workshop on research impact, (2) workshop on demonstrating impact, and (3) sessions to guide dissemination, including interactive tools and consultation with the TSBM research team. Fifteen IRI alumni were invited to participate in the pilot; six responded agreeing to participate in the training, develop TSBM case studies, and provide feedback about their experiences. Participants applied the tools and gave feedback on design, usability, and content. We present their case studies and describe how the IRI used the results to incorporate TSBM into future trainings.
Results:
The case studies identified 40 benefits spanning all four TSBM domains, including 21 community, 11 policy, five economic, and three clinical benefits. Participants reported that TSBM training helped them develop a framework for talking about impact. Selecting benefits was challenging for early-stage projects, suggesting the importance of early training.
Conclusions:
The case studies showcased the institute’s impact and the fellows’ work and informed refinement of tools and methods for incorporating TSBM into future IRI training.
The proportion of physician-investigators involved in biomedical research is shrinking even as the need for high-quality, interdisciplinary research is growing. Building the physician-investigator workforce is thus a pressing concern. Flexible, “light-weight” training modalities can help busy physician-investigators prepare for key stages of the research life cycle and personalize their learning to their own needs. Such training can also support researchers from diverse backgrounds and lighten the work of mentors.
Materials and Methods:
The University of Pittsburgh’s Institute for Clinical Research Education designed the Stackables Microcredentials in Clinical and Translational Research (Stackables) program to provide flexible, online training to supplement and enhance formal training programs. This training utilizes a self-paced, just-in-time format along with an interactive, storytelling approach to sustain learner engagement. Learners earn badges for completing modules and certificates for completing “stacks” in key competency areas. In this paper, we describe the genesis and development of the Stackables program and report the results of a pilot study in which we evaluated changes in confidence in key skill areas from pretest to posttest, as well as engagement and perceived effectiveness.
Results:
Our Stackables pilot study showed statistically significant gains in learner confidence in all skill areas from pretest to posttest. Pilot participants reported that the module generated high levels of engagement and enhanced their skills, knowledge, and interest in the subject.
Conclusions:
Stackables provide an important complement to formal coursework by focusing on discrete skill areas and allowing learners to access the training they need when they need it.
The University of California (UC) Davis Clinical and Translational Science Center has established the “Join the Team” model, a Clinical Research Coordinator workforce pipeline utilizing a community-based approach. The model has been extensively tested at UC Davis and demonstrated to generate a viable pathway for qualified candidates for employment in clinical research. The model combines the following elements: community outreach; professional training materials created by the Association for Clinical Research Professionals and adapted to the local environment; financial support to trainees to encourage ethnic and socioeconomic diversity; and internship/shadowing opportunities. The program is tailored for academic medical centers (AMCs) in recognition of administrative barriers specific to AMCs. UC Davis’s model can be replicated at other locations using information in this article, such as key program features and barriers faced and surmounted. We also discuss innovative theories for future program iterations.
With the rise of online references, podcasts, webinars, self-test tools, and social media, it is worthwhile to understand whether textbooks continue to provide value in medical education, and to assess the capacity they serve during fellowship training.
Methods:
A prospective mixed-methods study based on surveys that were disseminated to seven paediatric cardiology fellowship programmes around the world. Participants were asked to read an assigned chapter of Anderson’s Pediatric Cardiology 4th Edition textbook, followed by the completion of the survey. Open-ended questions included theming and grouping responses as appropriate.
Results:
The survey was completed by 36 participants. When asked about the content, organisation, and utility of the chapter, responses were generally positive, at greater than 89%. The chapters, overall, were rated relatively easy to read, scoring at 6.91, with standard deviations plus or minus 1.72, on a scale from 1 to 10, with higher values meaning better results. When asked to rank their preferences in where they obtain educational content, textbooks were ranked the second highest, with in-person teaching ranking first. Several themes were identified including the limitations of the use of textbook use, their value, and ways to enhance learning from their reading. There was also a near-unanimous desire for more time to self-learn and read during fellowship.
Conclusions:
Textbooks are still highly valued by trainees. Many opportunities exist, nonetheless, to improve how they can be organised to deliver information optimally. Future efforts should look towards making them more accessible, and to include more resources for asynchronous learning.
After close examination of the Allied campaigns of the SWPA, the importance of the Australian infantry brigade as a key combat formation is without question. An examination of the infantry brigade group (jungle) as an intermediate formation commanding infantry battalions and numerous attached units demonstrates the role of an infantry brigade as crucial to the victories in New Guinea and Borneo. The complex terrain of the SWPA islands, which sometimes constrained and at times isolated the brigades, offered these formations the opportunity to evolve.
The 18th Australian Infantry Brigade returned from the Buna and Sanananda campaigns a victorious but physically broken force. It had suffered more than 96 per cent casualties owing to a combination of weather, terrain, disease and the enemy, and would have to reconstruct the foundations of the brigade, built around a core of experienced veterans and the assimilation of motorised troops and replacement soldiers.1 The 18th Brigade would have to start building basic soldiering skills, the integration of jungle warfare lessons learnt, and the introduction of formal brigade leadership schools. This is also the period when the brigade undergoes a dramatic reorganisation under 7th Division’s establishment as a jungle division, which was outlined in chapter 1.